I agree with 5 Rings about the consequences of psuedo food; its why I called for "less calories and more real food". I disagree with this though:

"no one chooses to place themselves in a socially and physically detrimental stateno one chooses to be in a position of ridicule and in which they will be held in contempt by their fellow man".

IMHO lots of people do exactly that. Pair that notion with this:

"That is why progressives want to legislate a cap and trade on whatever they want to label as "fattening". To be able to control what people are unable to do for themselves."

and we have a formula that lays the foundation for destruction of freedom. We may humorously call it "food nazi fascism" but the underlying point is actually a serious one. To be a free society we must be a society wherein people are responsible for themselves.

I resubmit the proposition that your theory is disproved by the numerous countries which have enough money and food to overeat, but don't do so.

We can only choose to a limited degree and not completely as I think you suggest. As 5 rings points out,the science is irrefutable.

Yet you want to ignore this and suggest it is free choice. I submit this is misguided. Certainly there is some choice involved but this does not explain all of it by any long shot. I am not a Democrat or a progressive. I don't want a nanny state. That is the progressive agenda. Not "my argument".

As 5 rings points out,

You probably burn hundreds and possibly thousands of calories a day. Most people don't and some couldn't whether they choose to or not. With regard to excercise the studies are quite clear. Very few people can lose and keep weight off without significant excercise.

I can't speak for other countries. Perhaps they walk more I don't know.

I don't want a nanny state. That is the progressive agenda. Not "my argument".

Reminds me of the smoking argument. It IS an addiction yet people quit everyday, so there is both choice and addiction. Food is as addicting i would think as a cigarette, probably more so because you always need to have some. People eat out of boredom, a routine and availability probably more than out of hunger. I think it is the deferred gratification argument. What do you want most versus what do you want now. Maybe you want a flat stomach and less load on yours knees, but what you want right now is to eat big, eat well, and eat often. I am definitely on the 'choice' side of this argument for most people and we know people make good and bad choices about all kinds of things. There are plenty of others where as the good doctor has pointed out, that it just won't ever happen and a staple in the stomach or a pill or other artificial solution is the best course of action.

Back to public policy and freedom, being out of shape is a lousy way to go through but shouldn't be illegal, shouldn't be decided by someone else and really isn't much of the government's business. When we turn to the government for health care is when someone else's personal behavior seems to become everyone's business - and that is mostly wrong IMO. Part of the problem is a consequence of wealth and part is tied to paying other people to do nothing and part has to so with so many people becoming wealthy enough that the cost of unlimited food is no issue. Either way, 25% of fresh foods get thrown out. I notice that friends who travel with expense accounts tend to eat excessively well. We have huge numbers of people who receive free food and have nothing but time available to consume it all because their productive activities were stopped by program eligibility requirements. How are they supposed to round up the will power to limit their diet to match their inactivity when nothing much else going on? Along with drug testing for welfare, we could put some limits on free food programs or change the structure of those programs for those who are unable to otherwise control their intake.

Actually, I have not seen the "irrefutable science" Nor does the most recent article posted by 5RingsFitness support or refute that being fat is not choice. A "theory" of us having a brain in the gut is just an unproven unscientific theory.

As Crafty points out, given that human beings are similar, why across the globe are people less fat than Americans? Are Frenchmen,Italians, and Englishmen, forget the politics so anatomically different from Americans that only Americans seem to be obese?

Perhaps "they do walk more"; but that is a choice. In Japan I am constantly walking and going up and down stairs. I don't need to exercise so often plus the food is healthy. Here, I need to watch my diet and exercise since I travel everywhere by car. My choice.Or perhaps Crafty because of his occupation does burn more calories; but that too is a choice.

In my Sensitometry Class (I like photography) last night, I watched an obese girl eat two burritos and french fries for a snack.I had a banana. We both made a choice.

The "irrefutable" math is eat less calories and you will lose weight. Eat zero and you will waste away and die. Eat more and you will gain. Further, burning or not burning calories will also affect weight. Exercise is important. Again, it is choice.

CCP said, "In 1969 the average chopped steak at a diner was 8 ounces. In 1999 it was 16 oz." Again that is choice. My wife and I, when we do eat beef will split a prime steak (quality versus quantity). Again, that is choice.

Baring thyroid issues and a few minor other medical issues, it's all choice.

To be fair, as CCP pointed out, I'm not saying "choice" is easy. It's much easier to eat fast food than cook. It's easier to and perhaps tasty to buy a dozen donuts. It's definitely not easy to lose a great deal of weight as CCP points out; but then again, don't gain it. That is choice.

5RingsFitness points out;"no one chooses to place themselves in a socially and physically detrimental stateno one chooses to be in a position of ridicule and in which they will be held in contempt by their fellow man"

But that is not true; through choice, i.e. I'ld rather go home and have a beer than hit the gym is a choice. The consequencesare that you you have possibly put yourself "in a socially and physically detrimental state"

I think 5RingsFitness is confusing wants with choice. No one "wants" to be fat, or socially disadvantaged, but they choose not to do somethingabout it. To paraphrase another post on "talent" I suppose we all want to be good golfers like Doug, but are not willing to make the choice to practice diligently. But that is my choice, my fault for not practicing. I can hardly blame Doug if he cleans my clock.

Back to Crafty's argument. Why throughout the world are American's the fattest? The answer cannot be found in medical sciencethat American's stomach's are any different, the answer lies that Americans choose to eat more and eat unhealthy. And/or burn less calories.

It's not rocket science; eat fewer calories or burn the calories and you will lose weight! But it's hard. It's easy to not practice my golf and go ride my motorcycle instead. And it's easy to pop that beer and have some chips versus going to the gym. I like beer and chips,so denying myself is hard. But that is still choice.

As a side note, I am not in favor of a nanny state either. If you choose to eat, that is your choice. And if it makes you happy,well good for you. Perhaps the joy of eating excessively an unhealthily offsets the higher morbidity and mortality of obese individuals.Fine; that too is a choice.

Is Obesity an illness? An analogy I've always liked is pregnancy. Medical plans used to not cover pregnancy. The theory being that becomingpregnant was a "choice" (assuming no complications which were always covered) and medical insurance was for the unexpected. If you want tohave a baby, well then you should pay for it. While I have no desire to to debate the social and political merits of covering pregnancy, there was a certain logic I thought. The law changed and pregnancy is now covered as an "illness". The same "logic" applies to obesity. Social norms, not medical science may dictate that obesity be covered as an illness. It's the nanny state...

In essence you are saying "All swans are white". My personal case is irrelevant and I make no reliance on it whatsover. Rather, if I can show even one black swan then your science/theory is disproved; I go further than one black swan though-- I say that "No, there are plenty of swans that are black".

I remember a wonderful dinner in Bern, Switzerland where we had people from many, many Euro countries and the question of national stereotypes was being bantered about (Italian women-- hot lingerie; Germans good work ethic, punctual; that sort of thing). So I asked for the stereotype of Americans. Came the answer: "Fat people in shorts and white socks." Ouch.

Seriously though, one simply does not see the extraordinary numbers of grotesquesly obese people we have here elsewhere, though plenty of "elsewheres" have more than enough money and food to be obese if they were to so choose.Just like in fighting and other aspects of Life, empiricism trumps theory

Healthy eating: The best (Mediterranean diet) and the worst (umm, some Southern fare)?

Was there ever a time when we didn't have a bottle of olive oil in the kitchen?

The traditional Mediterranean diet was introduced to Americans about 17 years ago after it officially was endorsed by the Harvard School of Public Health and the World Health Organization. With an emphasis on fruits, vegetables, nuts and whole grains as well as more fish and less red meat, the diet continues to be the darling of doctors and nutritionists.

If you aren't familiar with the details of this food plan, MayoClinic.com provides a food pyramid and easy-to-follow steps in "Mediterranean diet: Choose this heart-healthy diet option."

So what are the worst foods to have in your diet? We hate to single out any particular cuisine for finger-wagging purposes; instead we'll let you draw your own conclusions from the photo essay "Southern heart attack foods."

I was speaking today to a nurse at one of the hospitals and we were talking about weight loss. She asked if I have ever seen the biggest loser? I said a few times for a few minutes. I don't need to watch what I already know. I can tell you that after their 15 minutes of fame is up, that within five years 95% of all those on that program will have gained back all their weight. So you are telling me these are unmotivated gluttens who "choose" to be fat?

And I forgot to add that the nurse said - these people are going through "torture". And that IS what it is for these people. Torture. Imagine going throught torture to lose all that weight. And then imagine expecting these people to literally plan on torturing themselves for the REST of their lives to maintain. With temptation every single minute of every single day! Forever.

Except for those very few unless they move to a deserted island it ain't gonna happen.

You want to say well then, it is their "choice", be my guest.

I say the evidence is clear that 10 or 15% weight loss is as much as almost all motivated *and* disciplined people are able to achieve over extended periods of time.

Whether due to too much food availability, too much TV or message boarding, too little exercise or what we can all theorize. But in the USA we have an epidemic of a disease called obesity.

That said I don't want Bamster or anyone else telling what I can eat or not.

The answer will hopefully come from the pharm industry but it is unlikely to be one pill that fits all. It might be combinations. Or brain and gut surgery. I don't know.

Or we cap and trade and try to tax are way out. Or we have a disaster and we all starve.

Thems the facts folks.

(Yes I have seen the motivational types showing us how we can eat like slobs and not gain weight and how delicious it is - so long as we eat vast quantities of lettuce, vegetables, and tofu.)

"So I asked for the stereotype of Americans. Came the answer: "Fat people in shorts and white socks." Ouch."

I have heard the same thing here from an doctor from India. The line I recall is Americans are "fat, lazy, and waste a lot".

I never said it's easy to lose weight. But it is a choice.

I'm still waiting for your explanation to Crafty and my question; why primarily Americans, not your Indian physician friend, or my Japanese friends, or Italians, or French, or English or German people in general are not fat or obese.

"I'm still waiting for your explanation to Crafty and my question; why primarily Americans, not your Indian physician friend, or my Japanese friends, or Italians, or French, or English or German people in general are not fat or obese."

"I'm still waiting for your explanation to Crafty and my question; why primarily Americans, not your Indian physician friend, or my Japanese friends, or Italians, or French, or English or German people in general are not fat or obese."

China's cities are getting bigger. Vast apartment complexes rise from land cleared for rebuilding. There's a constant hum of construction cranes and motion across the horizon. China's middle class is getting bigger, better educated, better paid. Millions of new consumers flock to the new shopping centers, freed from the hard physical labor of their parents and grandparents.

All that change has consequences. The Chinese are getting bigger, too, and fast. "The New England Journal of Medicine" reports that 19 million people in China are now obese. And while the small percentage of overweight people here still falls well short of America's epidemic, China's rapid rate of increased obesity, 30 to 50 percent annually -- that's six million to 10 million more each year -- has alarmed health officials.

In the course of just a few decades, China has moved from being a society with a fear of periodic famine to one where the rapidly rising rate of obesity is a serious public health threat.

Dr. Mi Jie is a pediatrician who is studying the phenomenon.

DR. MI JIE, pediatrician (through translator): During the last 30 years of economic development, people's living standards have improved rapidly. Their lifestyles have changed enormously. More money means more food.

RAY SUAREZ: Dr. Mi is trying to convince parents that giving their children more food just because they can afford more food will eventually become a health burden for that child.

DR. MI JIE (through translator): Most obese children don't have an immediate health risk, but health problems, such as high blood pressure, diabetes and cardiovascular diseases, will occur in 20 or 30 years, when they become adults, because health problems don't appear until adulthood. Parents don't see the problems. And they don't take action.

In fact, the traditional thinking in China is that children need to be fat, and that means the child is healthy and strong. This concept, of course, is wrong.

RAY SUAREZ: Western fast-food restaurants have become part of urban Chinese culture.

I just want to know what everybody's favorite food is at McDonald's.

CHILD: Hamburger. Coke.

WOMAN (through translator): The kids these days, they can eat whatever they want. When I was young, I was from a poor family, and we didn't have enough to eat. All we had were potatoes.

RAY SUAREZ: Paul French is the author of a soon-to-be-released book titled "Fat China."

PAUL FRENCH, author, "Fat China": They are extremely proud. And what we have here, of course, is a one-child policy, which is not enforced everywhere, but is still the norm.

So, now we have a generation coming through that not only have no siblings, but have no aunts and uncles. This has led to what we might term here the six-pocket syndrome, which is where every child, or little emperor, as they're known here, has two parents and four grandparents.

And those four grandparents and two parents don't really have anything to spend their money on except that child. So, they are lavishing that child. They are arguably spoiling that one child. And, of course, after generations of -- of not having enough, people don't want to say no to children. They want to give them everything. They want to let them enjoy the prosperity, rather than the austerity that they knew in their childhood.

RAY SUAREZ: According to the World Health Organization, between 5 percent and 10 percent of Chinese youth are now obese. Some of them make their way to the equivalent of a fat farm.

Here at the Aimin Fat Reduction Hospital, patients are not only introduced to healthier foods and daily exercise; they're also given traditional Chinese medical treatments, like acupuncture.

DR. SHI LIDONG, chief executive, Aimin Fat Reduction Hospital (through translator): With acupuncture, we want to control the appetite, the desire of eating, and so they won't feel very hungry. We use it to improve digestion and to break down the fat.

RAY SUAREZ: Dr. Shi Lidong is the hospital's chief executive.

DR. SHI LIDONG (through translator): The appearance of the body is not important to us. Our goal is to change their lifestyle, help them understand what to eat and what not to eat.

RAY SUAREZ: The parents of 19-year-old Ma Chanwang paid for his visit to Aimin. His goal is to lose 40 pounds. Now in his fifth day, he's already lost 15.

MAN (through translator): I started gaining weight when I was 8 years old. And I never stopped gaining. I like to eat deep-fried food, and I can't control my appetite.

RAY SUAREZ: As American-owned fast-food joints pop up around the country, they have been followed by another American cultural symbol: Weight Watchers. At Weight Watchers in Shanghai, program director Shan Jin works with clients to limit the amount of food at mealtime.

IIRC GM wrote that obesity is following the spread of wealth in China. Wealth has not yet spread across the countryside and I would doubt that healthcare enough even to check them for obesity has spread that far either. The proportion I think you are looking for would be 19 million out of how many checked and my curiosity would ask that out of the 19 million, how many are linked to newer wealth and how many are linked to poverty. In America I think that obesity link goes both ways. In China I doubt that coal miners, workers in the fields or kids in sweatshops are immersed in sugar and soda or suffering from inactivity.

between a full time jobprivate clients, teaching classesand filling in for Sifu whilst he is out if townhave not had time to come back to this

choice= options available, ability to make a decisionhealth= somewhat ambiguous though I think most would agree that being free of disease and able to meet the daily exigencies of life would fit the billtheory= a proven hypothesis, a set of facts based on observation that can be used to predict future outcomes

if any one takes the time to google rats, obesity, addiction they will find some entertaining and compelling research

fact stress hormone cascade causes reduction in flow to the cortex ( we get stupid, make worse choices) reduction in cellular protein uptake ( eat all you want, only about 3 of 10 grams of protein will be used for cell turnover, the other 7 become fat ) reduction of GABA which leads to more fuzzy thinking and bad sleep patterns, add all of that to a sedentary lifestyle, bad food available in massive quantities at low cost, good food being hard to find in some areas and near nonexistent in others, the reaction our brain has to said bad food (wired for feelings of satiety with fat salt sweet) .....

yepthem obese folk are just stupid rubes that don't had the sense to see that they are dying a slow and horrific death, ostracized from the pack (society), if the could just choose to not be biologically the same as the rest of he human specie they would be better.....

selah

Logged

"Nations have passed away and left no traces, And history gives the naked cause of it - One single simple reason in all cases; They fell because their peoples were not fit."-Rudyard Kipling

In the US, the poor have lots of food and little activity. In China, their poor have little food and lots of physical activity. It's in the cities, with the new wealth and "American-like" lifestyles that you'll find obesity a problem.

R Rings, truly I get what you are saying, but if your theories were true then they would be true across the board. So, to put a specific name to one of the many examples that contradict the conclusions of your theories: What do you make of the case of Switzerland? There is a very high standard of living, all the food that one could want-- including the best fg chocolate in the world!- and fatness is quite rare.

precisely so"a high standard of living"less stressmore leisure timemore active life stylesless access to the kinds of "food" we have here

does not disprove, rather highlights the point I am makingand as stated by other membersactivity level is a determining factor

most folks here in the US spend more time prone or seated than movingand when they do move, it tends to ne in a seated positionwith little regard for function, chasing caloric intake goals and unreasonable body images

six pack abs are a producible low bodyfat percentage not muscular developmenta giant ass can be the result of deadlifting as easily as never moving it

we have not even addressed body image dystopia and parietal lobe disordersor feedback loops stemming from trauma

choice is pretty vague

sometimes as active and fit individuals we may find ourselves falling into the trap of thinking since we find it easy than everyone should be able to do it as easily, whatever it is

talk to a mugging victim about stick fighting if they were successful in defending themselves they will likely be receptiveif not however the terror just talking about it can bring up is a thing to behold

if mom gave you a candy bar whenever you did rightyou will have that wired in

the neurons that wire together fire together

food is a drug

addiction is no joke

do junkie choose to be junkies or is it a process that starts witha choice and ends with the monkey

Logged

"Nations have passed away and left no traces, And history gives the naked cause of it - One single simple reason in all cases; They fell because their peoples were not fit."-Rudyard Kipling

As pointed out, obesity is minimal in "rich" countries like Switzerland, Germany, Italy, France, England (heck most of Western Europe) plus Japan, South Korea et al.

Are they anatomically different than us? Of course not. Are they neurobiologically different than us? No. They simply make better choices!

I agree "most folks here in the US spend more time prone or seated than movingand when they do move, it tends to ne in a seated positionwith little regard for function, chasing caloric intake goals and unreasonable body images"

But that is choice.

Simply look at the overwhelming empirical evidence. Not unproven theory.

***When the full explanation for the modern epidemic of obesity has emerged***

Of course the explanation to many of my friends here on this forum is that it is simply a matter of choice but I post this for fun anyway:

****ObesityDoes light make you fat?When—not just what—mice eat affects how much weight they put on Oct 14th 2010

Illuminating the cause of obesityTHE blame for rising obesity rates has been pinned on many things, including a more calorific diet, the spread of processed food, a lack of exercise and modern man’s generally more stressful lot. Something else may soon be included in the list: brighter nights.

Light regulates the body’s biological clock—priming an individual’s metabolism for predictable events such as meals and slumber. Previous research has shown that, in mice at least, the genes responsible for this can be manipulated so as to make the animals plumper and more susceptible to problems associated with obesity, including diabetes and heart disease. It was not known, though, whether simply altering ambient light intensity might have similar effects.

A team of researchers led by Laura Fonken of Ohio State University has cleared the matter up. As they report in the Proceedings of the National Academy of Sciences, they examined how nocturnal light affects weight, body fat and glucose intolerance (the underlying cause of late-onset diabetes) in male mice. They found that persistent exposure to even a little night-time light leads to increases in all three.

To reach this conclusion Dr Fonken split her murine subjects into three groups. Some were kept in cages lit constantly, so as to resemble a never-ending overcast day. A second group lived in conditions akin to their natural habitat, with 16 hours of overcast day-like light, followed by eight hours of darkness. The remaining rodents were also exposed to a cycle, but the dark was replaced with a dim glow equivalent to the twilight at the first flickers of dawn.

Over the eight-week period of the experiment the mice in the first and third groups gained almost 50% more weight than those exposed to the natural light-dark cycle. They also put on more fat and exhibited reduced tolerance of glucose, despite eating comparable amounts of food and moving around just as much.

The only thing that seemed to differ was when the mice ate. In the wild, mice are nocturnal. Unsurprisingly, then, those in the quasi-natural conditions consumed only about a third of their food in the “day” phase. For a mouse exposed to the twilight cycle, however, the figure was over 55%.

In a follow-up experiment, Dr Fonken looked at whether the timing of food consumption alone could explain the observed differences. It turned out that those forced to eat during the “day”—ie, out of whack with their biological clock—did indeed gain about 10% more weight than those fed at “night” (be it dark or just dim) or those with uninterrupted access to grub.

How this might relate to people will require further investigation. Mice and humans are physiologically alike, so a similar effect might be expected for people, but the fact that mice are nocturnal and humans diurnal is a serious complicating factor. It is true, though, that the spread of electric lighting means many people eat their main meal when natural daylight is long gone—the obverse of a mouse eating during daylight hours. And that tendency to eat late, though it has never been tested properly, is believed by many nutritionists to be a factor in putting on weight.

When the full explanation for the modern epidemic of obesity has emerged, it is unlikely that the spread of artificial lighting will be the whole of it. But this work suggests it might be a part. When you eat could be as important as what you eat.

CCP, interesting stuff. Your position on this surprised me. I learned some things from your posts and I have learned a lot from 5 rings as well. He says he isn't a doctor but his view has the endorsement of ours. We all (IMHO) should acknowledge that in certain extreme cases obesity is caused by bodily defect like gland/hormone appetite metabolism dysfunction. I think you are mainly talking about problems that set in after major weight gain. It seems to me that losing weight is a different matter than maintaining good weight. Curing chronic obesity on your own or with the quick fix plans is maybe as easy as getting your virginity back after a few years of shall we say undisciplined behavior. It sounds like the body of the obese sends false signals for more food than it needs. So this wound may have started as self-inflicted, but grows into an illness. I can buy that. From the point of view of the MD, prescribing a pill or a procedure may be a big part of the only strategy with a real chance for success.

But why is it so common for the masses was the question. Because the right choice seems so distant or inconvenient or difficult in the environment we live in. An environment of immediate gratification, widespread inactivity and the (almost) unlimited availability of lousy choices.

All of that said, I still side with the others as to the preponderance of obesity. As I posted regarding economics, decline is a choice.

After my first full week of white shirt, dark tie and suit type work as a young adult I felt exhausted, but with nearly no exercise. First order getting off non-physical work may be to go have a drink. Add the social side to that and you find that people like to go out, which mostly means eat and drink. After a drink or two and you don't crave exercise, you crave food. Eat to excess and you still don't crave the exercise you missed. More likely that person ends up on the couch at home until they start thinking about more food and then go to bed with a full stomach and still no exercise.

Add parenting to that. Stay home more and life revolves around the kitchen. Drive the kids to soccer, tennis, scouts, you name it. Cheer and support them all you want but you still end up tired, hungry and thirsty without exercise.

Crafty at some point went from white collar training to this very disciplined and physical career choice. In my case I had a very strong involvement in more than one sport. My decision to keep going in those sports as a young adult kept me with immediate feedback from opponents if and when i lose a step, and that kept me coming beck to reasonable levels of fitness for a number of decades. It is easy to see how others without an interest in a sport or exercise could start to slide.

For the poor it gets even worse as I have previously posted. You are paid for your unproductivity, paid to try to get a note from your doctor that you are incapable of substantial economic gain, paid to have more children - literally, and then given a virtually unlimited food card good at all grocers without supervision.

I don't buy that people are unaware when this is happening to them. People know they had to replace their wardrobe every time they grew another size.

It comes back to what 5 rings wrote: "define choice"

Yes. That is exactly the nut of the matter. The right choice might not have seemed like it was one of the choices offered. The choice maybe seemed to be go to the bar or drink at home or at friends' houses.. Choosing between the all you eat buffet or super-size fast food. It was only 39 cents extra to super-size, batter value, why not? But those weren't really the only choices. Go to the casino or read at home. Watch television or pop in a movie. Hire to have the lawn mowed or move to a place where they take care of that etc. Now we have video game and internet addiction to add to all of that. Some have a spouse who is a great cook but pushes the eating agenda even further to the top. The right choice didn't always seem to be on the menu. Push away from the table. Portion your lunch and build it at home. We can make exceptions for all people with a bodily or medical defect, but for the rest - choices were made along the way. A choice not to do what it takes to stay reasonably fit. A choice not to push away from the table when you knew that really was enough. No one is saying easy choices if everything in your environment is pulling you the other direction. Sometimes not obvious choices. But they were choices that needed to be made to stay in any kind of shape. Otherwise, decline of your health and fitness is your choice. (MHO)

Humans are hunter-gatherers by nature. Our existence using agriculture and high tech is but a tick of the evolutionary clock. As a hunter-gatherer, very few environments have an easy access to sweet or fatty food. We crave them because they are very useful/valuable and rare in that setting. No hunter-gatherers suffered from obesity. They ate as much as possible, because one never knew when/if the next meal was coming. Now we still have the same inborn impulses, but a very different access to food and much less in the way of physical demands for most of us.

I too think CCP as an MD has made some excellent points about when a person is already truly obese that "prescribing a pill or a procedure may be a big part of the only strategy with a real chance for success." Also, I concur that we "all (IMHO) should acknowledge that in certain extreme cases obesity is caused by bodily defect like gland/hormone appetite metabolism dysfunction"

And I think 5RingsFitness as a Personal Trainer has brought an interesting perspective making some good points about the difficulty of losing weight.

But the cause of, the preponderance of the evidence supports that it is choice. You point out that the decision is not easy. That's true. Yet, some here in America, most throughout Europe and Asia are able to make that choice not to be obese or overweight. It' not easy, but in the long making a difficult/healthy choice now will pay off later. Maybe it is like economics?

"Now we still have the same inborn impulses, but a very different access to food and much less in the way of physical demands for most of us."

With regards to Doug's comment:

"I don't buy that people are unaware when this is happening to them"

Generally I agree but the insidious nature of obesity and weight gain is more incredible than I ever realized. Anyone ever watch that show on calbe, "I eat 33,000 calories a day"? There is a scene where a 350 or 400 pound lady was followed around for a day and they wrote down everything that she ate in a course of an average day.

Next the went and fixed her several full plates of food the exact same she ate and laid out all these plates on a round table. They brought her into the room and said to her THIS IS WHAT YOU EAT IN A TYPICAL DAY!!!

Well her repsonse was astonishing. Her eyes bugged open, her mouth fell agape and she just stood there in shock saying, "I eat all this in a day!?. This is disgusting."

Well, now I am sitting there watching this the same as everyone else thinking how on earth could this fat lady be stuffing all this food in her fat mouth all day long and NOT know it?

The denial some people have is being belief. Of course she is extreme, but my point is that it isn't as straight forward as some would like to think.

There have been other shows about this. One followed around three people who are succesful in losing large amount of weight and keeping it off. But when I tell you it is a FULL time job I mean it. These people spend all day long fighting and planning and motivating, and excercising, and cooking, and avoiding and keeping themselves focused. They show one woman woaling around her house in excercise leotards. She teaches aerobics and does her own at home as well. Another guy is shown running for two hours a day and spending lots of time planning and cooking his healthy meals.

Folks you have no idea how hard it is in our society to keep and lose weight off for most people. That is why a 10 to 15 % goal is reasonable and achievable for most with discipline and motivation. More maybe for some but not many.

Regarding the 33,000 calorie lady, we used to have freak shows at the state fair. Now we don't have the shows and they aren't called freaks anymore. Obesity in general raises moral, moral hazard and libertarian issues. One argument to legalize drugs was the law of natural consequences and learning. People can choose not to be a heroin addict if we allow that path and let people see where it leads. One consequence of the 33,000 calorie lady is that at some point she would lose her ability to hunt and gather. A self correcting problem. Enter public policies. As she becomes unable to function, the consequence is the opposite. We put her on public payroll and buy her more food. And healthcare, no matter the cost. In the name and spirit of being humane we took away the corrective mechanism that worked for tens of thousands of years.

Who should have to pay? I find it interesting that some companies are instituting a no smokingpolicy in their hiring practices for health insurance cost savings, yet obesity costs far more than smoking. Perhaps we need to institute a no obesity policy i.e. if your weight (BMI) is above a certain level you will not be hired and/or if it reaches a certain level you will be fired. Similar to the corporate no smoking policies.Seems logical and fair... And cost effective.

Then again I am for individual freedom so I don't agree with any of these policies.

No, you did not use the word "assisting". My mistake CCP. I apologize. However I did put it in quotes.

I understand but am not sure your analogy applies in this instance. This particular woman "has made clear she wants to become the heaviest for the explicit reason of making money off it"

Doug's comment "do no harm" made me wonder how a physician could even be party to this abomination.

Yet you are right; merely treating her and hopefully advising her against her reality show quest to become even more obese is not "assisting" her. And eventually, if not now, she will truly need medical care (the main point of my posting). And we willall pay for her poor choice....

Lies, Damned Lies, and Medical ScienceMUCH OF WHAT MEDICAL RESEARCHERS CONCLUDE IN THEIR STUDIES IS MISLEADING, EXAGGERATED, OR FLAT-OUT WRONG. SO WHY ARE DOCTORS—TO A STRIKING EXTENT—STILL DRAWING UPON MISINFORMATION IN THEIR EVERYDAY PRACTICE? DR. JOHN IOANNIDIS HAS SPENT HIS CAREER CHALLENGING HIS PEERS BY EXPOSING THEIR BAD SCIENCE.

By David H. Freedman

IMAGE CREDIT: ROBYN TWOMEY/REDUX

IN 2001, RUMORS were circulating in Greek hospitals that surgery residents, eager to rack up scalpel time, were falsely diagnosing hapless Albanian immigrants with appendicitis. At the University of Ioannina medical school’s teaching hospital, a newly minted doctor named Athina Tatsioni was discussing the rumors with colleagues when a professor who had overheard asked her if she’d like to try to prove whether they were true—he seemed to be almost daring her. She accepted the challenge and, with the professor’s and other colleagues’ help, eventually produced a formal study showing that, for whatever reason, the appendices removed from patients with Albanian names in six Greek hospitals were more than three times as likely to be perfectly healthy as those removed from patients with Greek names. “It was hard to find a journal willing to publish it, but we did,” recalls Tatsioni. “I also discovered that I really liked research.” Good thing, because the study had actually been a sort of audition. The professor, it turned out, had been putting together a team of exceptionally brash and curious young clinicians and Ph.D.s to join him in tackling an unusual and controversial agenda.

Last spring, I sat in on one of the team’s weekly meetings on the medical school’s campus, which is plunked crazily across a series of sharp hills. The building in which we met, like most at the school, had the look of a barracks and was festooned with political graffiti. But the group convened in a spacious conference room that would have been at home at a Silicon Valley start-up. Sprawled around a large table were Tatsioni and eight other youngish Greek researchers and physicians who, in contrast to the pasty younger staff frequently seen in U.S. hospitals, looked like the casually glamorous cast of a television medical drama. The professor, a dapper and soft-spoken man named John Ioannidis, loosely presided.

One of the researchers, a biostatistician named Georgia Salanti, fired up a laptop and projector and started to take the group through a study she and a few colleagues were completing that asked this question: were drug companies manipulating published research to make their drugs look good? Salanti ticked off data that seemed to indicate they were, but the other team members almost immediately started interrupting. One noted that Salanti’s study didn’t address the fact that drug-company research wasn’t measuring critically important “hard” outcomes for patients, such as survival versus death, and instead tended to measure “softer” outcomes, such as self-reported symptoms (“my chest doesn’t hurt as much today”). Another pointed out that Salanti’s study ignored the fact that when drug-company data seemed to show patients’ health improving, the data often failed to show that the drug was responsible, or that the improvement was more than marginal.

Salanti remained poised, as if the grilling were par for the course, and gamely acknowledged that the suggestions were all good—but a single study can’t prove everything, she said. Just as I was getting the sense that the data in drug studies were endlessly malleable, Ioannidis, who had mostly been listening, delivered what felt like a coup de grâce: wasn’t it possible, he asked, that drug companies were carefully selecting the topics of their studies—for example, comparing their new drugs against those already known to be inferior to others on the market—so that they were ahead of the game even before the data juggling began? “Maybe sometimes it’s the questions that are biased, not the answers,” he said, flashing a friendly smile. Everyone nodded. Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all. Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted?

That question has been central to Ioannidis’s career. He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem.

THE CITY OF IOANNINA is a big college town a short drive from the ruins of a 20,000-seat amphitheater and a Zeusian sanctuary built at the site of the Dodona oracle. The oracle was said to have issued pronouncements to priests through the rustling of a sacred oak tree. Today, a different oak tree at the site provides visitors with a chance to try their own hands at extracting a prophecy. “I take all the researchers who visit me here, and almost every single one of them asks the tree the same question,” Ioannidis tells me, as we contemplate the tree the day after the team’s meeting. “‘Will my research grant be approved?’” He chuckles, but Ioannidis (pronounced yo-NEE-dees) tends to laugh not so much in mirth as to soften the sting of his attack. And sure enough, he goes on to suggest that an obsession with winning funding has gone a long way toward weakening the reliability of medical research.

He first stumbled on the sorts of problems plaguing the field, he explains, as a young physician-researcher in the early 1990s at Harvard. At the time, he was interested in diagnosing rare diseases, for which a lack of case data can leave doctors with little to go on other than intuition and rules of thumb. But he noticed that doctors seemed to proceed in much the same manner even when it came to cancer, heart disease, and other common ailments. Where were the hard data that would back up their treatment decisions? There was plenty of published research, but much of it was remarkably unscientific, based largely on observations of a small number of cases. A new “evidence-based medicine” movement was just starting to gather force, and Ioannidis decided to throw himself into it, working first with prominent researchers at Tufts University and then taking positions at Johns Hopkins University and the National Institutes of Health. He was unusually well armed: he had been a math prodigy of near-celebrity status in high school in Greece, and had followed his parents, who were both physician-researchers, into medicine. Now he’d have a chance to combine math and medicine by applying rigorous statistical analysis to what seemed a surprisingly sloppy field. “I assumed that everything we physicians did was basically right, but now I was going to help verify it,” he says. “All we’d have to do was systematically review the evidence, trust what it told us, and then everything would be perfect.”

It didn’t turn out that way. In poring over medical journals, he was struck by how many findings of all types were refuted by later findings. Of course, medical-science “never minds” are hardly secret. And they sometimes make headlines, as when in recent years large studies or growing consensuses of researchers concluded that mammograms, colonoscopies, and PSA tests are far less useful cancer-detection tools than we had been told; or when widely prescribed antidepressants such as Prozac, Zoloft, and Paxil were revealed to be no more effective than a placebo for most cases of depression; or when we learned that staying out of the sun entirely can actually increase cancer risks; or when we were told that the advice to drink lots of water during intense exercise was potentially fatal; or when, last April, we were informed that taking fish oil, exercising, and doing puzzles doesn’t really help fend off Alzheimer’s disease, as long claimed. Peer-reviewed studies have come to opposite conclusions on whether using cell phones can cause brain cancer, whether sleeping more than eight hours a night is healthful or dangerous, whether taking aspirin every day is more likely to save your life or cut it short, and whether routine angioplasty works better than pills to unclog heart arteries.

But beyond the headlines, Ioannidis was shocked at the range and reach of the reversals he was seeing in everyday medical research. “Randomized controlled trials,” which compare how one group responds to a treatment against how an identical group fares without the treatment, had long been considered nearly unshakable evidence, but they, too, ended up being wrong some of the time. “I realized even our gold-standard research had a lot of problems,” he says. Baffled, he started looking for the specific ways in which studies were going wrong. And before long he discovered that the range of errors being committed was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals.

This array suggested a bigger, underlying dysfunction, and Ioannidis thought he knew what it was. “The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” Researchers headed into their studies wanting certain results—and, lo and behold, they were getting them. We think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it’s easy to manipulate results, even unintentionally or unconsciously. “At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” says Ioannidis. “There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded.”

Perhaps only a minority of researchers were succumbing to this bias, but their distorted findings were having an outsize effect on published research. To get funding and tenured positions, and often merely to stay afloat, researchers have to get their work published in well-regarded journals, where rejection rates can climb above 90 percent. Not surprisingly, the studies that tend to make the grade are those with eye-catching findings. But while coming up with eye-catching theories is relatively easy, getting reality to bear them out is another matter. The great majority collapse under the weight of contradictory data when studied rigorously. Imagine, though, that five different research teams test an interesting theory that’s making the rounds, and four of the groups correctly prove the idea false, while the one less cautious group incorrectly “proves” it true through some combination of error, fluke, and clever selection of data. Guess whose findings your doctor ends up reading about in the journal, and you end up hearing about on the evening news? Researchers can sometimes win attention by refuting a prominent finding, which can help to at least raise doubts about results, but in general it is far more rewarding to add a new insight or exciting-sounding twist to existing research than to retest its basic premises—after all, simply re-proving someone else’s results is unlikely to get you published, and attempting to undermine the work of respected colleagues can have ugly professional repercussions.

In the late 1990s, Ioannidis set up a base at the University of Ioannina. He pulled together his team, which remains largely intact today, and started chipping away at the problem in a series of papers that pointed out specific ways certain studies were getting misleading results. Other meta-researchers were also starting to spotlight disturbingly high rates of error in the medical literature. But Ioannidis wanted to get the big picture across, and to do so with solid data, clear reasoning, and good statistical analysis. The project dragged on, until finally he retreated to the tiny island of Sikinos in the Aegean Sea, where he drew inspiration from the relatively primitive surroundings and the intellectual traditions they recalled. “A pervasive theme of ancient Greek literature is that you need to pursue the truth, no matter what the truth might be,” he says. In 2005, he unleashed two papers that challenged the foundations of medical research.

He chose to publish one paper, fittingly, in the online journal PLoS Medicine, which is committed to running any methodologically sound article without regard to how “interesting” the results may be. In the paper, Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time. Simply put, if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right. His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials. The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using the peer-review process—in which journals ask researchers to help decide which studies to publish—to suppress opposing views. “You can question some of the details of John’s calculations, but it’s hard to argue that the essential ideas aren’t absolutely correct,” says Doug Altman, an Oxford University researcher who directs the Centre for Statistics in Medicine.

Still, Ioannidis anticipated that the community might shrug off his findings: sure, a lot of dubious research makes it into journals, but we researchers and physicians know to ignore it and focus on the good stuff, so what’s the big deal? The other paper headed off that claim. He zoomed in on 49 of the most highly regarded research findings in medicine over the previous 13 years, as judged by the science community’s two standard measures: the papers had appeared in the journals most widely cited in research articles, and the 49 articles themselves were the most widely cited articles in these journals. These were articles that helped lead to the widespread popularity of treatments such as the use of hormone-replacement therapy for menopausal women, vitamin E to reduce the risk of heart disease, coronary stents to ward off heart attacks, and daily low-dose aspirin to control blood pressure and prevent heart attacks and strokes. Ioannidis was putting his contentions to the test not against run-of-the-mill research, or even merely well-accepted research, but against the absolute tip of the research pyramid. Of the 49 articles, 45 claimed to have uncovered effective interventions. Thirty-four of these claims had been retested, and 14 of these, or 41 percent, had been convincingly shown to be wrong or significantly exaggerated. If between a third and a half of the most acclaimed research in medicine was proving untrustworthy, the scope and impact of the problem were undeniable. That article was published in the Journal of the American Medical Association.

DRIVING ME BACK to campus in his smallish SUV—after insisting, as he apparently does with all his visitors, on showing me a nearby lake and the six monasteries situated on an islet within it—Ioannidis apologized profusely for running a yellow light, explaining with a laugh that he didn’t trust the truck behind him to stop. Considering his willingness, even eagerness, to slap the face of the medical-research community, Ioannidis comes off as thoughtful, upbeat, and deeply civil. He’s a careful listener, and his frequent grin and semi-apologetic chuckle can make the sharp prodding of his arguments seem almost good-natured. He is as quick, if not quicker, to question his own motives and competence as anyone else’s. A neat and compact 45-year-old with a trim mustache, he presents as a sort of dashing nerd—Giancarlo Giannini with a bit of Mr. Bean.

The humility and graciousness seem to serve him well in getting across a message that is not easy to digest or, for that matter, believe: that even highly regarded researchers at prestigious institutions sometimes churn out attention-grabbing findings rather than findings likely to be right. But Ioannidis points out that obviously questionable findings cram the pages of top medical journals, not to mention the morning headlines. Consider, he says, the endless stream of results from nutritional studies in which researchers follow thousands of people for some number of years, tracking what they eat and what supplements they take, and how their health changes over the course of the study. “Then the researchers start asking, ‘What did vitamin E do? What did vitamin C or D or A do? What changed with calorie intake, or protein or fat intake? What happened to cholesterol levels? Who got what type of cancer?’” he says. “They run everything through the mill, one at a time, and they start finding associations, and eventually conclude that vitamin X lowers the risk of cancer Y, or this food helps with the risk of that disease.” In a single week this fall, Google’s news page offered these headlines: “More Omega-3 Fats Didn’t Aid Heart Patients”; “Fruits, Vegetables Cut Cancer Risk for Smokers”; “Soy May Ease Sleep Problems in Older Women”; and dozens of similar stories.

When a five-year study of 10,000 people finds that those who take more vitamin X are less likely to get cancer Y, you’d think you have pretty good reason to take more vitamin X, and physicians routinely pass these recommendations on to patients. But these studies often sharply conflict with one another. Studies have gone back and forth on the cancer-preventing powers of vitamins A, D, and E; on the heart-health benefits of eating fat and carbs; and even on the question of whether being overweight is more likely to extend or shorten your life. How should we choose among these dueling, high-profile nutritional findings? Ioannidis suggests a simple approach: ignore them all.

For starters, he explains, the odds are that in any large database of many nutritional and health factors, there will be a few apparent connections that are in fact merely flukes, not real health effects—it’s a bit like combing through long, random strings of letters and claiming there’s an important message in any words that happen to turn up. But even if a study managed to highlight a genuine health connection to some nutrient, you’re unlikely to benefit much from taking more of it, because we consume thousands of nutrients that act together as a sort of network, and changing intake of just one of them is bound to cause ripples throughout the network that are far too complex for these studies to detect, and that may be as likely to harm you as help you. Even if changing that one factor does bring on the claimed improvement, there’s still a good chance that it won’t do you much good in the long run, because these studies rarely go on long enough to track the decades-long course of disease and ultimately death. Instead, they track easily measurable health “markers” such as cholesterol levels, blood pressure, and blood-sugar levels, and meta-experts have shown that changes in these markers often don’t correlate as well with long-term health as we have been led to believe.

On the relatively rare occasions when a study does go on long enough to track mortality, the findings frequently upend those of the shorter studies. (For example, though the vast majority of studies of overweight individuals link excess weight to ill health, the longest of them haven’t convincingly shown that overweight people are likely to die sooner, and a few of them have seemingly demonstrated that moderately overweight people are likely to live longer.) And these problems are aside from ubiquitous measurement errors (for example, people habitually misreport their diets in studies), routine misanalysis (researchers rely on complex software capable of juggling results in ways they don’t always understand), and the less common, but serious, problem of outright fraud (which has been revealed, in confidential surveys, to be much more widespread than scientists like to acknowledge).

If a study somehow avoids every one of these problems and finds a real connection to long-term changes in health, you’re still not guaranteed to benefit, because studies report average results that typically represent a vast range of individual outcomes. Should you be among the lucky minority that stands to benefit, don’t expect a noticeable improvement in your health, because studies usually detect only modest effects that merely tend to whittle your chances of succumbing to a particular disease from small to somewhat smaller. “The odds that anything useful will survive from any of these studies are poor,” says Ioannidis—dismissing in a breath a good chunk of the research into which we sink about $100 billion a year in the United States alone.

And so it goes for all medical studies, he says. Indeed, nutritional studies aren’t the worst. Drug studies have the added corruptive force of financial conflict of interest. The exciting links between genes and various diseases and traits that are relentlessly hyped in the press for heralding miraculous around-the-corner treatments for everything from colon cancer to schizophrenia have in the past proved so vulnerable to error and distortion, Ioannidis has found, that in some cases you’d have done about as well by throwing darts at a chart of the genome. (These studies seem to have improved somewhat in recent years, but whether they will hold up or be useful in treatment are still open questions.) Vioxx, Zelnorm, and Baycol were among the widely prescribed drugs found to be safe and effective in large randomized controlled trials before the drugs were yanked from the market as unsafe or not so effective, or both.

“Often the claims made by studies are so extravagant that you can immediately cross them out without needing to know much about the specific problems with the studies,” Ioannidis says. But of course it’s that very extravagance of claim (one large randomized controlled trial even proved that secret prayer by unknown parties can save the lives of heart-surgery patients, while another proved that secret prayer can harm them) that helps gets these findings into journals and then into our treatments and lifestyles, especially when the claim builds on impressive-sounding evidence. “Even when the evidence shows that a particular research idea is wrong, if you have thousands of scientists who have invested their careers in it, they’ll continue to publish papers on it,” he says. “It’s like an epidemic, in the sense that they’re infected with these wrong ideas, and they’re spreading it to other researchers through journals.”

THOUGH SCIENTISTS AND science journalists are constantly talking up the value of the peer-review process, researchers admit among themselves that biased, erroneous, and even blatantly fraudulent studies easily slip through it. Nature, the grande dame of science journals, stated in a 2006 editorial, “Scientists understand that peer review per se provides only a minimal assurance of quality, and that the public conception of peer review as a stamp of authentication is far from the truth.” What’s more, the peer-review process often pressures researchers to shy away from striking out in genuinely new directions, and instead to build on the findings of their colleagues (that is, their potential reviewers) in ways that only seem like breakthroughs—as with the exciting-sounding gene linkages (autism genes identified!) and nutritional findings (olive oil lowers blood pressure!) that are really just dubious and conflicting variations on a theme.

Most journal editors don’t even claim to protect against the problems that plague these studies. University and government research overseers rarely step in to directly enforce research quality, and when they do, the science community goes ballistic over the outside interference. The ultimate protection against research error and bias is supposed to come from the way scientists constantly retest each other’s results—except they don’t. Only the most prominent findings are likely to be put to the test, because there’s likely to be publication payoff in firming up the proof, or contradicting it.

But even for medicine’s most influential studies, the evidence sometimes remains surprisingly narrow. Of those 45 super-cited studies that Ioannidis focused on, 11 had never been retested. Perhaps worse, Ioannidis found that even when a research error is outed, it typically persists for years or even decades. He looked at three prominent health studies from the 1980s and 1990s that were each later soundly refuted, and discovered that researchers continued to cite the original results as correct more often than as flawed—in one case for at least 12 years after the results were discredited.

Doctors may notice that their patients don’t seem to fare as well with certain treatments as the literature would lead them to expect, but the field is appropriately conditioned to subjugate such anecdotal evidence to study findings. Yet much, perhaps even most, of what doctors do has never been formally put to the test in credible studies, given that the need to do so became obvious to the field only in the 1990s, leaving it playing catch-up with a century or more of non-evidence-based medicine, and contributing to Ioannidis’s shockingly high estimate of the degree to which medical knowledge is flawed. That we’re not routinely made seriously ill by this shortfall, he argues, is due largely to the fact that most medical interventions and advice don’t address life-and-death situations, but rather aim to leave us marginally healthier or less unhealthy, so we usually neither gain nor risk all that much.

Medical research is not especially plagued with wrongness. Other meta-research experts have confirmed that similar issues distort research in all fields of science, from physics to economics (where the highly regarded economists J. Bradford DeLong and Kevin Lang once showed how a remarkably consistent paucity of strong evidence in published economics studies made it unlikely that any of them were right). And needless to say, things only get worse when it comes to the pop expertise that endlessly spews at us from diet, relationship, investment, and parenting gurus and pundits. But we expect more of scientists, and especially of medical scientists, given that we believe we are staking our lives on their results. The public hardly recognizes how bad a bet this is. The medical community itself might still be largely oblivious to the scope of the problem, if Ioannidis hadn’t forced a confrontation when he published his studies in 2005.

Ioannidis initially thought the community might come out fighting. Instead, it seemed relieved, as if it had been guiltily waiting for someone to blow the whistle, and eager to hear more. David Gorski, a surgeon and researcher at Detroit’s Barbara Ann Karmanos Cancer Institute, noted in his prominent medical blog that when he presented Ioannidis’s paper on highly cited research at a professional meeting, “not a single one of my surgical colleagues was the least bit surprised or disturbed by its findings.” Ioannidis offers a theory for the relatively calm reception. “I think that people didn’t feel I was only trying to provoke them, because I showed that it was a community problem, instead of pointing fingers at individual examples of bad research,” he says. In a sense, he gave scientists an opportunity to cluck about the wrongness without having to acknowledge that they themselves succumb to it—it was something everyone else did.

To say that Ioannidis’s work has been embraced would be an understatement. His PLoS Medicine paper is the most downloaded in the journal’s history, and it’s not even Ioannidis’s most-cited work—that would be a paper he published in Nature Genetics on the problems with gene-link studies. Other researchers are eager to work with him: he has published papers with 1,328 different co-authors at 538 institutions in 43 countries, he says. Last year he received, by his estimate, invitations to speak at 1,000 conferences and institutions around the world, and he was accepting an average of about five invitations a month until a case last year of excessive-travel-induced vertigo led him to cut back. Even so, in the weeks before I visited him he had addressed an AIDS conference in San Francisco, the European Society for Clinical Investigation, Harvard’s School of Public Health, and the medical schools at Stanford and Tufts.

The irony of his having achieved this sort of success by accusing the medical-research community of chasing after success is not lost on him, and he notes that it ought to raise the question of whether he himself might be pumping up his findings. “If I did a study and the results showed that in fact there wasn’t really much bias in research, would I be willing to publish it?” he asks. “That would create a real psychological conflict for me.” But his bigger worry, he says, is that while his fellow researchers seem to be getting the message, he hasn’t necessarily forced anyone to do a better job. He fears he won’t in the end have done much to improve anyone’s health. “There may not be fierce objections to what I’m saying,” he explains. “But it’s difficult to change the way that everyday doctors, patients, and healthy people think and behave.”

AS HELTER-SKELTER as the University of Ioannina Medical School campus looks, the hospital abutting it looks reassuringly stolid. Athina Tatsioni has offered to take me on a tour of the facility, but we make it only as far as the entrance when she is greeted—accosted, really—by a worried-looking older woman. Tatsioni, normally a bit reserved, is warm and animated with the woman, and the two have a brief but intense conversation before embracing and saying goodbye. Tatsioni explains to me that the woman and her husband were patients of hers years ago; now the husband has been admitted to the hospital with abdominal pains, and Tatsioni has promised she’ll stop by his room later to say hello. Recalling the appendicitis story, I prod a bit, and she confesses she plans to do her own exam. She needs to be circumspect, though, so she won’t appear to be second-guessing the other doctors.

Tatsioni doesn’t so much fear that someone will carve out the man’s healthy appendix. Rather, she’s concerned that, like many patients, he’ll end up with prescriptions for multiple drugs that will do little to help him, and may well harm him. “Usually what happens is that the doctor will ask for a suite of biochemical tests—liver fat, pancreas function, and so on,” she tells me. “The tests could turn up something, but they’re probably irrelevant. Just having a good talk with the patient and getting a close history is much more likely to tell me what’s wrong.” Of course, the doctors have all been trained to order these tests, she notes, and doing so is a lot quicker than a long bedside chat. They’re also trained to ply the patient with whatever drugs might help whack any errant test numbers back into line. What they’re not trained to do is to go back and look at the research papers that helped make these drugs the standard of care. “When you look the papers up, you often find the drugs didn’t even work better than a placebo. And no one tested how they worked in combination with the other drugs,” she says. “Just taking the patient off everything can improve their health right away.” But not only is checking out the research another time-consuming task, patients often don’t even like it when they’re taken off their drugs, she explains; they find their prescriptions reassuring.

Later, Ioannidis tells me he makes a point of having several clinicians on his team. “Researchers and physicians often don’t understand each other; they speak different languages,” he says. Knowing that some of his researchers are spending more than half their time seeing patients makes him feel the team is better positioned to bridge that gap; their experience informs the team’s research with firsthand knowledge, and helps the team shape its papers in a way more likely to hit home with physicians. It’s not that he envisions doctors making all their decisions based solely on solid evidence—there’s simply too much complexity in patient treatment to pin down every situation with a great study. “Doctors need to rely on instinct and judgment to make choices,” he says. “But these choices should be as informed as possible by the evidence. And if the evidence isn’t good, doctors should know that, too. And so should patients.”

In fact, the question of whether the problems with medical research should be broadcast to the public is a sticky one in the meta-research community. Already feeling that they’re fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren’t eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding. Ioannidis dismisses these concerns. “If we don’t tell the public about these problems, then we’re no better than nonscientists who falsely claim they can heal,” he says. “If the drugs don’t work and we’re not sure how to treat something, why should we claim differently? Some fear that there may be less funding because we stop claiming we can prove we have miraculous treatments. But if we can’t really provide those miracles, how long will we be able to fool the public anyway? The scientific enterprise is probably the most fantastic achievement in human history, but that doesn’t mean we have a right to overstate what we’re accomplishing.”

We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that’s dressed up to seem more right than it is, scientists will keep delivering exactly that.

“Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”

"“I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”

Very few studies lead to changes in the way we practice. Much more leads to quackery in the media, wall street, and homeopathic industry as well as the "established" medical community.

But before we jump on this author's bandwagon one thing is certain.

His view is exactly the view held by those who are have constructed battle plans to take over our health care and to decide what does and what does not get paid for.

They will make it almost impossible to prove a benefit for something and hence be able to say it ain't proven thus we do not see a reason to pay for it. They will force it the other way.

Overweight/obese? It is depressing just looking at the people on the street. And it's getting worse.And yet it truly is all choice.

Contrary to some thought, excluding the few with a true medical condition (thyroid, etc.)People do choose to place themselves in a socially and physically detrimental stateAnd people do choose to be in a position of ridicule and in which they will be held in contempt by their fellow man.Otherwise they would choose to do something positive about it.NOT doing anything, not making a choice to change, is still a choice.

Dr. Sanjay Gupta points out it's not easy, but it is simple...Just choose to do something about it.

'Eat less. Move more...all these overweight people never thought of that either.'

Doc, It doesn't work if they only think about it, they have to do it for it to work.

Same advice might likely apply to most knee, hip, back issues - the load bearing areas of the body being asked to carry the wrong sized load. Also the location of the load moves outward with increases in size. Just tell them to lose the excess baggage and get back to you... I think you will lose your license if you do. They are looking for staples and pills by the time they come to you for weight loss. Sometimes that is what they need.

My grandpa always enjoyed telling us that in the early 1960s I think, WAY before warning labels, his doctor told him to quit smoking - 'Neal, those cigarettes are going to kill you.' No one told him about addiction or offered him patches, pills or hypnosis, but he did quit - right then. Everybody is different.